All People With Eating Disorders Are Underweight, Right?

Dispelling three common myths about eating disorders

As a clinical psychologist with an expertise in eating disorders, people frequently tell me stories about their experiences with eating and weight. Some tell painful stories of watching loved ones deal with severe symptoms. Some express their own struggles around dieting and body image. Some describe trying to treat patients. And some just ask questions.

In these interactions, it is clear to me that most people want to understand eating disorders. They are interested. They want to learn. They want to help or be helped. What these people have in common is a need for basic facts about eating disorders. And, many of them are misinformed.

Below are the three biggest myths that I hear about eating disorders. These myths often lead us to under-recognize and misunderstand the experiences of people struggling with these complex disorders.

1. All People with Eating Disorders are Underweight.
Technically, there are eight different feeding and eating disorders that someone could be diagnosed with according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Of these, anorexia nervosa, bulimia nervosa, and binge eating disorder are the most publically-recognized and widely researched (1). Yet, of these disorders, only anorexia nervosa is associated with being significantly underweight. In fact, individuals with bulimia nervosa are generally average weight or slightly overweight and about half of people with binge eating disorder are obese. Consequently, it is not true that all people with eating disorders are underweight.

2. Eating Disorders are Not That Serious.
Often, the media sensationalizes and trivializes eating disorder symptoms (2,3). This leads many people to think that eating disorders are minor struggles that don't really affect peoples lives in a meaningful way. The truth is that eating disorders are incredibly serious mental disorders characterized by problems in eating behavior and body image. They are highly comorbid with other mental illness: the large majority of individuals who have an eating disorder also have at least one other psychological disorder (4). And, although each eating disorder is unique, all are associated with serious psychological, physical, and social impairment. Consequently, eating disorders are very serious psychological disorders that should not be minimized or taken lightly.

3. Eating Disorders Only Affect Young, White Women.
Although eating disorders usually develop during adolescence or young adulthood and are more prevalent in women than men, recent research suggests that eating disorders often affect people of all genders, ethnicities, ages, and socioeconomic groups. For example, in a community-based sample of over 2000 adults, about 3.5% of women and 2% of men met lifetime criteria for binge eating disorder (5). Furthermore, in a large sample of data collected from three national surveys, lifetime prevalence of binge eating disorder was similar in Asian American, African American, White/European American, and Hispanic/Latinos, ranging from 1.3% in Asian Americans to 2.1% in Latinos (6). Furthermore, bulimia nervosa was more common in Latinos and African Americans than Whites. Consequently, eating disorders do not only affect young, White women.

The Naked Truth: In today’s society, most of us have been in contact with and personally affected by someone who has struggled with an eating disorder. Additionally, almost everyone has personally struggled with their eating, felt negatively about their physical appearance, or worried about their weight at some point in their life. Yet, our image of the typical person struggling with an eating disorder is often incredibly narrow and inaccurate. It is important to broaden our view of what a person with an eating disorder “looks like” to ensure appropriate assessment, diagnosis, and treatment.